The MNA, but not the DETERMINE, screening tool is a valid indicator of nutritional status in elderly Africans.

OBJECTIVES We compared the validity of existing nutrition screening tools for use in older South Africans. METHODS This was a cross-sectional study in 283 free-living and institutionalized black South Africans > or = 60 y of age. Trained fieldworkers administered a 24-h recall, the DETERMINE and Mini-Nutritional Assessment (MNA) screening tools, and performed anthropometric measurements and physical function tests. Biochemical indicators assessed included serum albumin, hemoglobin, ferritin, vitamin B12, red blood cell folate, cholesterol, and vitamin C. The six-item Cognitive Impairment Test was used to assess cognitive function. RESULTS The MNA score was positively and significantly associated with anthropometric measurements, cognitive function, instrumental activities of daily living and, in women only, percentage of body fat, handgrip strength, and activities of daily living. Compared with the MNA, the DETERMINE instrument had a low positive predictive value (55.6%) and specificity (11.2%), resulting in a high rate of false positives classified as being malnourished. CONCLUSION The MNA, but not the DETERMINE, screening tool is appropriate for use in identifying older black South Africans who are malnourished or at risk of malnutrition.

[1]  J. Woo,et al.  Risk factor change in older persons, a perspective from Hong Kong: weight change and mortality. , 1994, Journal of gerontology.

[2]  A. Roche,et al.  Some anthropometric indices of body composition for elderly adults. , 1986, Journal of gerontology.

[3]  K. Charlton,et al.  Poor nutritional status in older black South Africans. , 2001, Asia Pacific journal of clinical nutrition.

[4]  P. S. Lipski,et al.  Australian Nutrition Screening Initiative , 1996 .

[5]  P. Delmas,et al.  Dietary supplementation in elderly patients with fractured neck of the femur , 1990, The Lancet.

[6]  S A Jebb,et al.  Critical evaluation of energy intake data using fundamental principles of energy physiology: 1. Derivation of cut-off limits to identify under-recording. , 1991, European journal of clinical nutrition.

[7]  S. Studenski,et al.  Functional Reach: A Marker of Physical Frailty , 1992, Journal of the American Geriatrics Society.

[8]  B. Vellas,et al.  Mini Nutritional Assessment (MNA): Research and Practice in the Elderly: 1st Nestl Clinical and Performance Nutrition Workshop, Mini Nutritional Assessment (MNA) - MNA in the Elderly, Lausanne, October 1997 , 1999 .

[9]  S. Ismail,et al.  Anthropometric characteristics of older people in rural Malawi , 1998, European Journal of Clinical Nutrition.

[10]  J. Beasley.  Body weight and longevity. , 1987, JAMA.

[11]  E. Cook,et al.  Body mass index and mortality among nonsmoking older persons. The Framingham Heart Study. , 1988, JAMA.

[12]  G. Barrera,et al.  Effects of nutritional supplementation and resistance training on muscle strength in free living elders. Results of one year follow. , 2004, The journal of nutrition, health & aging.

[13]  M. Manandhar,et al.  The nutritional status of older Rwandan refugees , 1998, Public Health Nutrition.

[14]  M. Lawton,et al.  Assessment of Older People: Self-Maintaining and Instrumental Activities of Daily Living , 1969 .

[15]  S. Johansson,et al.  Nutritional status, as determined by the Mini-Nutritional Assessment, and osteoporosis: a cross-sectional study of an elderly female population , 2006, European Journal of Clinical Nutrition.

[16]  S B Roberts,et al.  Exercise training and nutritional supplementation for physical frailty in very elderly people. , 1994, The New England journal of medicine.

[17]  U S Nayak,et al.  Balance in elderly patients: the "get-up and go" test. , 1986, Archives of physical medicine and rehabilitation.

[18]  D. D. de Luis,et al.  Impact of dietary intake and nutritional status on outcomes after liver transplantation. , 2006, Revista espanola de enfermedades digestivas : organo oficial de la Sociedad Espanola de Patologia Digestiva.

[19]  L. Rubenstein,et al.  The Mini Nutritional Assessment-Short Form for preoperative nutritional evaluation of elderly patients , 2001, Aging.

[20]  R B Wallace,et al.  Lower-extremity function in persons over the age of 70 years as a predictor of subsequent disability. , 1995, The New England journal of medicine.

[21]  S. EduardoAtalah,et al.  Validación del criterio de evaluación nutricional global del adulto mayor , 2001 .

[22]  P. Kelly,et al.  A study of nutritional deficits of long-stay geriatric patients. , 1993, Age and ageing.

[23]  P. Fentem,et al.  Changes in body fat and muscle in manual workers at and after retirement , 2006, European Journal of Applied Physiology and Occupational Physiology.

[24]  H. Vorster,et al.  The development and testing of a food portion photograph book for use in an African population. , 2000, Journal of human nutrition and dietetics : the official journal of the British Dietetic Association.

[25]  Mahoney Fi,et al.  FUNCTIONAL EVALUATION: THE BARTHEL INDEX. , 1965 .

[26]  R. Katzman.,et al.  Validation of a short Orientation-Memory-Concentration Test of cognitive impairment. , 1983, The American journal of psychiatry.

[27]  J. M. Davies,et al.  Strength, power and related functional ability of healthy people aged 65-89 years. , 1994, Age and ageing.

[28]  P. Wilson,et al.  Prevalence of cobalamin deficiency in the Framingham elderly population. , 1994, The American journal of clinical nutrition.

[29]  R. Bullock,et al.  Validation of a 6 item cognitive impairment test with a view to primary care usage , 1999, International journal of geriatric psychiatry.

[30]  A. Siegelaub,et al.  Thinness and mortality. , 1987, American journal of public health.

[31]  L. Bourne.  Dietary intake in an urban African population in South Africa, with special reference to the nutrition transition , 1996 .

[32]  P J Garry,et al.  Assessing the nutritional status of the elderly: The Mini Nutritional Assessment as part of the geriatric evaluation. , 2009, Nutrition reviews.

[33]  L. Harris,et al.  DIAGNOSIS OF VITAMIN-C SUBNUTRITION BY URINE ANALYSIS: WITH A NOTE ON THE ANTISCORBUTIC VALUE OF HUMAN MILK , 1935 .

[34]  N. Wellman.  The Nutrition Screening Initiative. , 2009, Nutrition reviews.

[35]  D. Rush.  Nutrition screening in old people: its place in a coherent practice of preventive health care. , 1997, Annual review of nutrition.

[36]  J. Judge,et al.  The Relationship Between Physical Performance Measures and Independence in Instrumental Activities of Daily Living , 1996 .

[37]  J. Lubben,et al.  Sexual activity and satisfaction among very old adults: results from a community-dwelling Medicare population survey. , 1997, The Gerontologist.

[38]  B. Vellas,et al.  Mini Nutritional Assessment (MNA): Research and Practice in the Elderly , 1999 .

[39]  S. Klein,et al.  Physical frailty and body composition in obese elderly men and women. , 2004, Obesity research.

[40]  J P McWhirter,et al.  Incidence and recognition of malnutrition in hospital , 1994, BMJ.

[41]  J. Morley,et al.  Nutritional Issues in Nursing Home Care , 1995, Annals of Internal Medicine.

[42]  J. Sorkin,et al.  Serum albumin level and physical disability as predictors of mortality in older persons. , 1994, JAMA.

[43]  J. Fischer,et al.  Low body weight and weight loss in the aged. , 1990, Journal of the American Dietetic Association.

[44]  J. Tur,et al.  Dietary intake and nutritional risk among free-living elderly people in Palma de Mallorca. , 2005, The journal of nutrition, health & aging.

[45]  P. Trumbo,et al.  Dietary reference intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein and amino acids. , 2002, Journal of the American Dietetic Association.

[46]  E. Lambert,et al.  Validation of a food frequency questionnaire in older South Africans , 1999 .

[47]  E. Ferriolli,et al.  Mini-nutritional assessment score and the risk for undernutrition in free-living older persons. , 2004, The journal of nutrition, health & aging.

[48]  W. Chumlea,et al.  Is the MNA valid in different populations and across practice settings? , 2006, The journal of nutrition, health & aging.

[49]  R. Bucks,et al.  Assessment of activities of daily living in dementia: development of the Bristol Activities of Daily Living Scale. , 1996, Age and ageing.

[50]  R. Walls,et al.  Impact of nutrition status on morbidity and mortality in a select population of geriatric rehabilitation patients. , 1990, The American journal of clinical nutrition.

[51]  Graham Lawton,et al.  Get up and go , 2006 .

[52]  S. Kumanyika,et al.  Body Weight as a Risk Factor in the Elderly , 1990 .

[53]  J. Nordenström,et al.  Nutritional Status Using Mini Nutritional Assessment and Subjective Global Assessment Predict Mortality in Geriatric Patients , 2002, Journal of the American Geriatrics Society.

[54]  S. Katz,et al.  Functional Assessment in Geriatrics , 1989, Journal of the American Geriatrics Society.

[55]  J. Manson,et al.  Body weight and longevity. A reassessment. , 1987, JAMA.

[56]  R. Engst.  Who Technical Report Series: No: 567. Evaluation of Certain Food Additives, 19. Report of the Joint FAO/WHO Expert Committee on Food Additives, 23 Seiten. World Health Organization, Geneva 1975, Preis: SFr. 5,— , 1976 .

[57]  Suzanne G. Leveille,et al.  Disability, physical activity, and muscle strength in older women: the Women's Health and Aging Study. , 1999, Archives of physical medicine and rehabilitation.

[58]  L. Cobiac,et al.  Corrected Arm Muscle Area: An Independent Predictor of Long‐Term Mortality in Community‐Dwelling Older Adults? , 2002, Journal of the American Geriatrics Society.

[59]  B. Vellas,et al.  Screening for undernutrition in geriatric practice: developing the short-form mini-nutritional assessment (MNA-SF). , 2001, The journals of gerontology. Series A, Biological sciences and medical sciences.